Healthcare Provider Details

I. General information

NPI: 1881996783
Provider Name (Legal Business Name): VICKI L NEAL LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2010
Last Update Date: 11/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 COLLEGE AVE
COLUMBUS OH
43209-2374
US

IV. Provider business mailing address

1475 BYCROFT RD
COLUMBUS OH
43206-3307
US

V. Phone/Fax

Practice location:
  • Phone: 614-231-1890
  • Fax: 614-231-4978
Mailing address:
  • Phone: 614-271-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0007572 SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: